Coronary heart disease is the leading cause of death among postmenopausal women. Yet few studies have examined the potential for altering risk factors for coronary heart diseases among postmenopausal women, especially as a result of comprehensive lifestyle changes. A pressing need exists for controlled studies to evaluate the effects of comprehensive lifestyle changes on risks for coronary heart disease among postmenopausal women. Based upon the work of Ornish and colleagues (1990) and work in which the investigator has been involved on adherence to diabetes regimens, this First Award project will develop and evaluate a comprehensive lifestyle self-management (CLSM) program (low-fat vegetarian diet, smoking cessation and stress management training) for postmenopausal women with coronary heart disease and Type II (non-insulin dependent) diabetes. The CLSM program appears to produce substantial cardiovascular benefits among men but little is known about the behavioral processes through which change occurs. Its generalizability and applicability -- especially for high-risk women -- is uncertain. The CLSM program will be compared to a usual care condition in an initial randomized trial. Outcome measures will include patient self-care behaviors and health outcomes (serum lipid profiles, blood pressure, relative weight, and glycemic control). Process measures will include self-efficacy, personal health models, perceived stress, social support and problem-solving skills. Study participants will be engaged in the intervention for three years and with gradual fading of the program in the third year to evaluate the long-term effects of the program. Analyses will include assessments of between groups differences on physiological risk factors, behavioral (lifestyle) measures and process measures as well as maintenance over time. Based upon the results of this study, the long-term goal is to design a second outcome study in which the revised intervention will be evaluated with a larger sample to determine the relative contribution of adding moderate exercise and the effects on reversal of coronary heart disease.